Clinical features and prognosis of acute pancreatitis in pregnancy

Objective To investigate the preventive and treatment measures for acute pancreatitis in pregnancy (APIP) , and to improve the awareness of this disease.Methods A total of 65 patients with APIP who were admitted to The Affiliated Hospital of Southwest Medical U-niversity from January 2013 to December 2017 were enrolled as subjects.Among these patients, 32 had mild acute pancreatitis (MAP) , 21had moderate-severe acute pancreatitis (MSAP) , and 12 had severe acute pancreatitis (SAP) .The three groups were compared in terms of laboratory results, maternal age, pregnancy complications, body mass index (BMI) , etiology, pregnancy, and maternal and fetal outcomes.An analysis of variance was used for comparison of normally distributed continuous data with homogeneity of variance between multiple groups, and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn-Bonferroni test was used for further comparison between two groups.The chi-square test was used for comparison of categorical data between groups.Results Of all patients, 36 (55.38%) had a blood amylase level three times higher than normal, and 41 (63.08%) had a serum lipase level three times higher than normal.The SAP group had significantly higher high-sensitivity C-reactive protein, triglyceride, and blood glucose and a significantly lower blood calcium level than the MAP and MSAP groups (all P<0.05) .All 65 patients underwent abdominal color Doppler ultrasound, among whom 51 (78.46%) had a correct diagnosis;28 patients underwent computed tomography and all of them had a correct diagnosis (100%) .The patients with gestational diabetes mellitus tended to develop MSAP and SAP (χ2=7.809, P=0.020) .The MSAP and SAP groups had a significantly higher BMI than the MAP group (P<0.05) .Of all patients, 26 (40.00%) had hyperlipidemia as the etiology of APIP, among whom 50.00%developed MSAP and 34.62%developed SAP (χ2=20.520, P<0.001) .With the increase in the severity of APIP, the rate of intrauterine death increased, and the 5-minute Apgar score of neonates decreased (χ2=25.381 and 14.821, both P<0.05) .ConclusionHyperlipidemia is the main cause of APIP and a major influencing factor for prognosis.The monitoring of blood lipids and BMI should be strengthened in pregnant women, in order to reduce the incidence rate and severity of APIP.